Physiotherapy

Editorial Board

2012-03-01

Management of respiratory problems in people with neurodegenerative conditions: a narrative review

U. Jones, S. Enright, M. Busse — 2011-05-09

Abstract: Background: Respiratory failure and dysfunction are common problems in many neurodegenerative conditions. Although physiotherapists manage these problems, it is not known which treatments have been studied and their efficacy.Objective: To review evidence on the management of respiratory problems in people with neurodegenerative conditions using the PRISMA approach.Data sources: Comprehensive searches were conducted using the following electronic databases from inception to May 2010: HUGEnet, SIGLE, British Library Direct, CINAHL, Medline, AMED and Web of Knowledge. Bibliographies of all studies and systematic reviews were searched by hand.Study selection: Studies were selected based on: self-ventilating participants with neurodegenerative conditions; interventions aimed at improving respiratory function; and any valid and reliable measures of respiratory function as outcomes.Study appraisal: Studies were appraised by one reviewer using the Critical Appraisal Skills Programme. Data were synthesised using a narrative approach.Results: Thirty-five studies were included in the review. The strongest evidence was for the use of non-invasive ventilation for people with amyotrophic lateral sclerosis, although this was weak. The evidence for the use of respiratory muscle training and methods to increase peak cough flow showed a positive effect, but was also weak.Conclusion: There is weak evidence for the positive effects of physiotherapeutic interventions for respiratory problems in people with neurodegenerative conditions. Further work is necessary in specific neurodegenerative conditions to identify why respiratory problems occur, and larger scale studies should be undertaken to investigate management of these problems.

Do patients with chronic low back pain have an altered level and/or pattern of physical activity compared to healthy individuals? A systematic review of the literature

D.W. Griffin, D.C. Harmon, N.M. Kennedy — 2011-06-08

Abstract: Background: It is commonly assumed that patients with chronic low back pain are less active than healthy individuals. There has been a recent increase in the number of studies published comparing the physical activity levels of patients with chronic low back pain and healthy individuals.Objectives: The aim of this systematic review was to determine, based on the current body of evidence, if patients with chronic low back pain have a lower level and/or altered pattern of physical activity compared with asymptomatic, healthy individuals.Data sources: The electronic databases Embase, Medline, ISI Web of Knowledge, Cinahl, Sport Discus and Nursing and Allied Health were searched from the beginning of each database until the end of December 2009.Review methods: Studies which compared the level and/or pattern of physical activity of patients with chronic low back pain and healthy controls were included. The quality of the included studies was assessed using an assessment tool based on the Newcastle-Ottawa Scale. The scale was modified for the purposes of this study.Results: Seven studies were included in the final review. Four studies recruited adult patients (18–65 years), two studies examined older adults (≥65 years) and one study recruited adolescents (<18 years). Pooled data revealed no significant difference in the overall activity level of adults or adolescents with CLBP, however there is evidence that older adults with chronic low back pain are less active than controls. The results suggest that patients exhibit an altered pattern of physical activity over the course of a day compared to controls. Major methodological limitations were identified and are discussed.Conclusion: There is no conclusive evidence that patients with chronic low back pain are less active than healthy individuals. Based on a limited number of studies, there is some evidence that the distribution of activities over the course of a day is different between patients with chronic low back pain and controls.

A systematic review of early rehabilitation methods following a rupture of the Achilles tendon

Rebecca S. Kearney, Katie R. McGuinness, Juul Achten, Matthew L. Costa — 2011-06-01

Abstract: Objectives: Rupture of the Achilles tendon is a debilitating injury. Advances have led to the development of immediate weight bearing rehabilitation. A range of early rehabilitation methods exist, but further research is required into this new area. The first stage in the investigation of a complex intervention is to identify its defining components. The aim of this review was to systemically identify and summarise, from clinical studies, the individual components that define immediate weight bearing rehabilitation protocols for the treatment of acute Achilles tendon rupture's.Data sources: The electronic databases MEDLINE, EMBASE, CINAHL, AMED and the register of current controlled trials were searched up to March 2010.Review methods: All study designs and languages were included. Two independent reviewers used pre-defined inclusion and exclusion criteria to identify all eligible articles. Eligible articles were summarised and critically reviewed, using the extension of the CONSORT statement for non-pharmacological interventions.Results: Two hundred and fifteen articles were screened, nine were included. These studies, presented the results of 424 patients; 236 who had surgery and 188 who were managed non-operatively. There were a range of rehabilitation protocols that were defined by four components. These components consisted of the degree of maintained plantarflexion, whether daily range of movement exercises were permitted, the type of orthotic and for how long it was worn.Conclusions: The efficacy of different immediate weight bearing rehabilitation protocols following an acute rupture of the Achilles tendon remains unclear. Further research is required to evaluate the identified components to optimise rehabilitation.

A process of informed consent for student learning through peer physical examination in pelvic floor physiotherapy practice

Clare Delany, Helena Frawley — 2011-05-30

Abstract: Peer physical examination (PPE) is a method of teaching and learning clinical skills in which students use fellow students as surrogate patients or models. PPE is recognised as useful as an experiential learning method to increase skill development for physiotherapy clinical practice. However students may feel pressured to participate despite discomfort and embarrassment when practising physical examination and treatment skills with their peers. Obtaining students’ informed consent to participate in PPE is an important process to address these disadvantages of PPE. This paper proposes a three stage process for obtaining informed consent from postgraduate physiotherapy students learning pelvic floor examination and treatment skills. The process is designed to encourage educators to articulate the ethical issues that are relevant in this area of teaching; to provide information to students to enable them to understand what is involved and to choose to participate, and to offer alternatives to participation through a formalised process of informed consent. These steps mirror students’ future obligations and actions when communicating with their patients.

Intertester reliability of a classification system for shoulder pain

2011-03-30

Abstract: Objective: To describe and determine the intertester reliability of a newly developed classification system of shoulder syndrome recognition.Design: Intertester reliability study.Setting: Fourteen primary care physiotherapy clinics.Participants: Two hundred and fifty-five patients with shoulder pain. Inclusion criterion: presence of shoulder pain aring within the glenohumeral or associated joints and structures. Exclusion criteria: previous shoulder surgery, surgical candidates, recognised malignancy, systemic illness, or concurrent cervical pain and/or radiculopathy.Intervention: Examiners were 55 physiotherapists who were arranged in pairs; each patient received two independent and blinded assessments, one by each of the paired physiotherapists. This shoulder classification approach contains three main clinical syndromes: Pattern 1 (impingement pain), Pattern 2 (acromioclavicular joint pain) and Pattern 3 (shoulder pain: frozen shoulder, glenohumeral arthritis, massive cuff tear, subscapularis tear, painful laxity, post-traumatic instability, internal derangement).Main outcome measures: Percentage agreement and Cohen's kappa coefficient.Results: The mean age of patients was 46.6 years (standard deviation 16.3, range 16 to 86), and 57% were male. Physiotherapists agreed on the pattern of shoulder pain for 205 of the 255 shoulders assessed (agreement rate 80%); the kappa coefficient was 0.664 (95% confidence interval 0.622 to 0.706; P<0.001). Of the 205 agreements, Pattern 1 was the most common condition; physiotherapists agreed on this pattern for 139 patients (68%). Both physiotherapists diagnosed Pattern 2 for 20 patients and Pattern 3 for 46 patients.Conclusion: This clearly defined system uses key elements of the history and examination to classify patients with shoulder pain. The kappa coefficient denotes good reproducibility.

Objective concurrent feedback on force parameters improves performance of lumbar mobilisation, but skill retention declines rapidly

Suzanne J. Snodgrass, Rachel A. Odelli — 2011-05-02

Abstract: Objective: To determine the optimum practice for students to apply lumbar mobilisations with force parameters consistent with an experienced therapist.Design: Thirty physiotherapy students attended three practice sessions over two weeks where they performed lumbar mobilisations on a fellow student. Students viewed feedback on their applied forces (measured using an instrumented treatment table) in real-time on a computer screen. Performance was tested before and after feedback at each practice session and at follow up sessions one week and three months later.Outcome measures: A greater accuracy in manual force application was defined as a smaller difference between each student-applied force parameter (mean peak force (N), force amplitude (N), and oscillation frequency (Hz)), and that previously applied by an expert. Test data from each session was analysed using Friedman's and Wilcoxon signed rank tests to determine student learning and retention.Results: Students were more accurate after feedback at Session 1 (median difference between student and expert force parameters 7.7N, IQR 3.2–15.3) than before feedback (median 17.5, IQR 7.3–33.6, P<0.001). Increased practice improved performance, with the greatest accuracy after feedback at Session 3 (median 7.0, IQR 3.5–11.9, P<0.01). Retention however was poor, with performance at follow-up sessions no different to baseline.Conclusions: Students apply more consistent and accurate mean peak force, force amplitude and oscillation frequency after practising with objective, concurrent feedback. Additional practice sessions further improve performance, however retention is poor.

Effect of lidocaine phonophoresis on sensory blockade: pulsed or continuous mode of therapeutic ultrasound?

2011-08-19

Abstract: Objective: The optimisation of drug absorption through skin is of great value in modern therapy. Phonophoresis is the use of therapeutic ultrasound to increase percutaneous drug absorption. However, few studies have compared pulsed and continuous modes of therapeutic ultrasound. This study compared these two modes by investigating the effect of lidocaine phonophoresis on sensory blockade. Lidocaine is a common local anaesthetic drug that is used topically to relieve pain and also for minor surgery.Design: Pre–post intervention study.Participants: Ninety-three healthy volunteers, assigned at random to one of three ultrasound groups: pulsed (ultrasound+lidocaine), continuous (ultrasound+lidocaine) and control (sham ultrasound+lidocaine).Intervention: Lidocaine (approximately 2cm3) was administered transdermally using a transducer.Outcome measures: Two-point discrimination, touch and maximum pain thresholds were assessed before and after the intervention in each group.Results: There were significant increases in two-point discrimination, touch and maximum pain thresholds after the intervention in all groups (P<0.05). The mean differences in the threshold changes between the pulsed and continuous groups were significant [two-point discrimination: mean difference 0.66 (standard deviation, SD 0.41)mm, 95% confidence interval (CI) 0.18 to 1.21, P<0.001; touch: mean difference 1.31 (SD 0.23)mA, 95% CI 0.98 to 1.96, P<0.001; maximum pain: mean difference 5.59 (SD 4.01)mA, 95% CI 1.01 to 10.11, P<0.001]. Statistical analysis also revealed significant differences for all senses between the pulsed and control groups [two-point discrimination: mean difference 0.61 (SD 0.29)mm, 95% CI 0.26 to 1.3, P<0.001; touch: mean difference 1.45 (SD 0.38)mA, 95% CI 0.96 to 2.1, P<0.001; maximum pain difference 9.17 (SD 4.13)mA, 95% CI 4.32 to 14.1, P<0.001]. The mean difference in the change in maximum pain threshold between the continuous and control groups was significant [mean difference 3.58 (SD 3.44)mA, 95% CI 0.09 to 8.3, P=0.001], but two-point discrimination and touch threshold changes revealed no significant difference between the continuous and control groups [two-point discrimination: mean difference 0.05 (SD 0.28)mm, 95% CI −0.31 to 0.48, P=0.968; touch: mean difference 0.14 (SD 0.19)mA, 95% CI −0.21 to 0.43, P=0.339].Conclusion: Pulsed ultrasound with topical lidocaine gel induced greater anaesthetic effect compared with continuous ultrasound with topical lidocaine gel and lidocaine application alone. The mechanical properties of pulsed ultrasound appear to be responsible for greater drug penetration.

Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis

2011-04-18

Abstract: Objective: To determine overall, test–retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis.Design: A reliability study using two raters and two test sessions.Setting: Tertiary care paediatric centre.Participants: Seventy participants aged between 10 and 20years with different types of idiopathic scoliosis (Cobb angle 15 to 60°) were recruited from the scoliosis clinic.Main outcome measures: Based on the XY co-ordinates of natural reference points (e.g. eyes) as well as markers placed on several anatomical landmarks, 32 angular and linear posture indices taken from digital photographs in the standing position were calculated from a specially developed software program. Generalisability theory served to estimate the reliability and standard error of measurement (SEM) for the overall, test–retest and inter-rater designs. Bland and Altman's method was also used to document agreement between sessions and raters.Results: In the random design, dependability coefficients demonstrated a moderate level of reliability for six posture indices (ϕ=0.51 to 0.72) and a good level of reliability for 26 posture indices out of 32 (ϕ≥0.79). Error attributable to marker placement was negligible for most indices. Limits of agreement and SEM values were larger for shoulder protraction, trunk list, Q angle, cervical lordosis and scoliosis angles. The most reproducible indices were waist angles and knee valgus and varus.Conclusions: Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis. Despite the good reliability of marker placement, other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time.

Attitudes of European physiotherapy students towards their chosen career in the context of different educational systems and legal regulations pertaining to the practice of physiotherapy: implications for university curricula

2011-05-02

Abstract: Objectives: Differences in the organisation of educational systems and regulations pertaining to the practice of a profession can influence the attitudes of students towards their chosen career and their perceptions of employment possibilities. The aim of this paper was to discuss the different educational systems and legal regulations pertaining to the practice of physiotherapy in selected countries of the European Union (EU), and to present some conclusions regarding the influence of these differences on the perceptions of first-year physiotherapy students on their chosen career.Design: Quantitative questionnaire-based study.Setting: Twenty-one university-level schools in the Czech Republic, Latvia, Malta, Poland, Spain and the UK.Participants: Six hundred and sixty-seven first-year physiotherapy students.Results: The mean response rate was 74%. Most students (79%) reported that a personal interest was the main reason why they had decided to study physiotherapy (79%). Most students from Spain and the Czech Republic reported that, on completion of their studies, they would like to work as physiotherapists (61/120, 51% Czech Republic; 140/250, 56% Spain), compared with only 4% of Polish students (P<0.001). Most students from Poland and Spain were not familiar with employment opportunities in their respective countries (202/250, 81% Spain; 212/250, 85% Poland), and claimed that it is difficult to find employment as a physiotherapist in their country. Most students from the Czech Republic, Latvia, Malta, Poland, Spain and the UK claimed that it is easy to find a job in other EU countries.Conclusion: Most physiotherapy students chose their course because of an interest in physiotherapy. They were not familiar with employment possibilities for graduates, and believed that it is easier to find work in other EU countries. Both factors may further aggravate the problem of unemployment among physiotherapists.

Defensive coping styles, anxiety and chronic low back pain

Sandra E. Lewis, Neil E. Fowler, Steve R. Woby, Paul S. Holmes — 2012-01-13

Psychological factors, such as anxiety, are associated with differences in pain perception and the prevalence of chronic pain conditions , such as chronic low back pain (CLBP) . Within other clinical populations, anxiety has also been considered in the context of high or low defensiveness to identify distinct coping styles, which have been associated with differences in treatment response and health outcomes . This has rarely been considered within CLBP.

Case report: Physiotherapy strategies for a woman with symphysis pubis diastasis occurring during labour

Jae-Hun Shim, Duck-Won Oh — 2011-04-21

Abstract: This case report demonstrates a therapeutic exercise program as a noninvasive functional treatment for symphysis pubis diastasis (SPD) and reports its results. A 32-year-old primigravida with SPD during labour received a specific functional exercise program, which consisted of abdominal stabilization and strengthening of the pelvic floor muscles, hip adductors, and extensors; training for bed mobility; and walking training with suitable aids. The program was performed for 1-hour per session, twice a day, for 2 weeks. Before the intervention, the patient was totally dependent on others for performing her daily activities owing to severe pain in the pelvic region. After the 2-week intervention, however, the interpubic distance was reduced by 36% (from 22mm to 14mm), and pain and functional disability were remarkably improved. Moreover, the patient could walk independently for 30m with a pelvic corset. Our results suggest that a systematically designed functional rehabilitation program may be beneficial in the functional recovery of patients suffering from SPD related to pregnancy.

Annette Harte — 2010-10-25

Howard Makofsky is an associate professor in the Department of Physical Therapy at the New York Institute of Technology, and he has been involved with manual therapy (clinical practice, teaching and research) for over 30 years. His wide experience is reflected in this book in that he brings together several different approaches to spinal manual therapy, not just in joint mobilisation/manipulation but also in soft tissue mobilisation and therapeutic exercise. This book has a strong osteopathic influence in some of the terminology used, and also refers regularly to the McKenzie principle. The book is well set out in subsections dealing initially with vertebral motion and principles of manual therapy examination. It is then split into sections on the scapulothoracic region, cervical spine, temporomandibular joint, lumbar spine and pelvic girdle. Each of these contains chapters on examination, connective tissue release, mobilisation/manipulation, and therapeutic and home exercises. The book is well illustrated by photographs which enable the reader to fully understand the techniques described. Makofsky also discusses evidence for spinal manual therapy and therapeutic exercise in a separate chapter towards the end of the book, and adds a chapter with case studies for the reader to work through with the answers available at the end of the chapter.

Clare Naylor — 2010-11-03

This book is part of a series aimed at athletic trainers and is divided into three parts: (i) principles of examination, (ii) region-specific examination strategies and (iii) recognition of general medical conditions. The authors appear to have a wealth of experience in athletic training, and the text is appropriately written for its target audience.